1124117684 NPI number — DR. JASON PEPPERD D.C.

Table of content: DR. JASON PEPPERD D.C. (NPI 1124117684)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124117684 NPI number — DR. JASON PEPPERD D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEPPERD
Provider First Name:
JASON
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124117684
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 30
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAND COULEE
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
99133-0030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
509-633-0861
Provider Business Mailing Address Fax Number:
509-633-0865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 MIDWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAND COULEE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99133-5013
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-633-0861
Provider Business Practice Location Address Fax Number:
509-633-0865
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  CH 00034872 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111N00000X , with the licence number: 406 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH0406 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com